Endoscopic Resection of Large Non-Pedunculated Colonic Polyps Without Submucosal Injection Is Safe and Effective with Adequate Technique

Background/Objectives: Endoscopic resection with lift polypectomy using submucosal injection (SI) for large non-pedunculated colorectal polyps is recommended to facilitate complete mucosal resection and decrease the risk of perforation; however, there are no studies comparing the safety and efficacy of large polypectomies with and without lift polypectomy. We aimed to evaluate the feasibility and safety of the polypectomy technique without SI compared to the routine use of SI. Methods: We performed a single tertiary center retrospective study evaluating all consecutive large non-pedunculated colorectal polyps (≥20 mm) referred to expert endoscopists in polypectomy from 2018 through 2021. We collected and analyzed data on demographics, polyp characteristics, resection technique, complications, and polyp recurrence in 6–12 months. Results: In 200 large non-pedunculated colonic polyp resections, 110 (55%) were performed with SI. The median polyp size was slightly larger in SI (30 mm IQR [20, 40] vs. 25 mm IQR [20, 30] in no-SI, p < 0.05), with a range of 20 to 130 mm. There were no differences in delayed bleeding rates. No perforation was noted in the no-SI group, and five perforations occurred in the SI group, without a statistically significant difference between groups. There was no statistically significant difference in the polyp recurrence rate at 6–12 months between the no-SI and SI groups (12% vs. 8% in no-SI vs. SI, respectively, p = 0.48). Conclusions: Complete removal of large non-pedunculated polyps without SI is feasible and safe in this large series. This approach had similar rates of clinically significant post-polypectomy bleeding and a non-significant difference in perforation rate compared to polyp resection with routine use of SI. Randomized trials are warranted to further assess the safety and efficacy of this approach.